Parc Sanitari Sant Joan de Deu, CIBERSAM. Universitat de Barcelona.
Adicciones. 2022 Apr 1;34(2):110-127. doi: 10.20882/adicciones.1504.
Although correct diagnosis and management of patients with schizophrenia and a comorbid substance use disorder (SUD) would determine a decrease in morbidity and mortality in these patients, development of efficient therapeutic strategies is still pending. We present recommendations on the pharmacological and psychological management of these patients following the 'PICO' structure (Patient-Intervention-Comparison-Outcomes). Evaluation of the quality of studies and summary of the evidence for each question was performed following the recommendations of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) working group. Our results suggest: 1) In patients with schizophrenia and cannabis use disorder, it is not possible to recommend one antipsychotic drug over another (between olanzapine, risperidone or haloperidol) for improving psychotic symptoms, reducing cannabis use, or improving pragmatic variables (weak recommendation). Clozapine cannot be recommended to reduce cannabis use (weak recommendation). 2) In patients with schizophrenia and cocaine use disorder we recommend haloperidol over olanzapine to reduce craving (moderate recommendation), and olanzapine over haloperidol to improve motor side effects in these patients (moderate recommendation). 3) In patients with schizophrenia and alcohol use disorder while naltrexone is recommended to reduce alcohol use (in terms of reducing alcohol craving) (weak recommendation), there is insufficient evidence to make any recommendation on the use of adjuvant acamprosate (weak recommendation). 4) In patients with schizophrenia and nicotine use disorder, adjuvant bupropion and varenicline are recommended for reducing nicotine use and nicotine abstinence (strong/moderate recommendation). 5) In patients with schizophrenia and polydrug use disorder, second-generation over first-generation antipsychotic drugs and olanzapine over other second-generation antipsychotics are recommended to improve psychotic symptoms (moderate/weak recommendation).
尽管正确诊断和管理患有精神分裂症和合并物质使用障碍（SUD）的患者将降低这些患者的发病率和死亡率，但仍需要开发有效的治疗策略。我们根据“PICO”结构（患者-干预-比较-结果）提出了这些患者的药理学和心理管理建议。根据 GRADE（推荐评估、制定与评价）工作组的建议，对每项问题的研究质量评估和证据总结进行了总结。我们的研究结果表明：1）对于患有精神分裂症和大麻使用障碍的患者，无法推荐一种抗精神病药物优于另一种药物（奥氮平、利培酮或氟哌啶醇），以改善精神病症状、减少大麻使用或改善实用变量（弱推荐）。氯氮平不能用于减少大麻使用（弱推荐）。2）对于患有精神分裂症和可卡因使用障碍的患者，我们建议使用氟哌啶醇而不是奥氮平来减少渴望（中度推荐），并建议使用奥氮平而不是氟哌啶醇来改善这些患者的运动副作用（中度推荐）。3）对于患有精神分裂症和酒精使用障碍的患者，推荐使用纳曲酮减少酒精使用（在减少酒精渴望方面）（弱推荐），但没有足够的证据推荐使用辅助性阿坎酸（弱推荐）。4）对于患有精神分裂症和尼古丁使用障碍的患者，推荐辅助用安非他酮和伐伦克林减少尼古丁使用和尼古丁戒断（强/中度推荐）。5）对于患有精神分裂症和多药使用障碍的患者，推荐第二代而非第一代抗精神病药物，以及奥氮平而非其他第二代抗精神病药物，以改善精神病症状（中度/弱推荐）。
